Wednesday, February 11, 2015

Supporting Recovery Without Enabling

This article is a copy of a recent blog posting by A. Thomas Horvath, Ph.D, president of SMART Recovery®

In Epidemics, Hippocrates said, “Make a habit of two things–to
help, or at least to do no harm.” How can we apply that idea to helping family
and friends with addictions?

When we care about individuals who are trying to overcome
addictions, we often face dilemmas in how best to help them. For instance, if I
help someone by providing money for some critical need, am I supporting
recovery by preventing some degree of “disaster”? Or, am I just shielding the
person from negative consequences that might motivate lasting behavior change?
The latter, of course, is AKA the E word: Enabling. This article will
identify some things to consider when you face that kind of decision.

What is support? I suggest that support, at its root, consists
of two things: paying attention and active helping. I could pay attention to a
friend who wants to quit smoking by listening to her talk about her cravings to
smoke and how she copes with these cravings. I could actively help her by
informing her of new tobacco cessation products (if she was unfamiliar with
them). I could take her to a SMART Recovery® meeting (especially if she felt
awkward going alone), or spend a non-smoking evening with her (when her
other options were to be alone or be with smokers).

How does support differ from enabling? One aspect of
support–paying attention– is unlikely to shield someone from negative
consequences. I probably am not making matters worse by complimenting successes
or joining in celebrating them. It’s unlikely to cause harm if I take time to
brainstorm alternative activities, take time to listen about stresses, express
confidence in future success, or just listen to the ups and downs of the
process of change.

Because paying attention is unlikely to harm, I encourage significant
others, even if they are ready to cut off other forms of helping, to continue
paying attention: “Son, your mom and I are drawing a line. We have provided
money for bail, for attorneys, for treatment, for rent, for food, on and on. We
have decided to stop, because we honestly don’t think it is really helping. We
help you out of a crisis, but as soon as you are out of it, you go back to
using. We think you have major addiction problems, but it’s up to you to decide
how to live. We think maybe you need to get yourself out of your crises, that
maybe that’s what’s needed to persuade you to change. But we are not ending our
relationship with you. We still want to see you and talk with you, every day if
you want. We hope you will see that we still love you deeply, and we hope our
love will help. But you are going to need to solve your own problems from now
on.” Note that although this statement may contain elements of “preaching,
complaining, criticizing, and nagging,” they are not prominent. The addiction
is discussed directly, but not judgmentally.

If we distinguish between paying attention and active helping,
it becomes possible to maintain some type of relationship with the addicted
individual, to the extent that both parties will make time for it. It is not
necessary for a family to tear itself apart over an addiction issue, although
this often happens. It is important for the family to make an early distinction
between paying attention and active helping, before painful feelings build up.

Even though the addiction may continue for awhile, the presence of valued
relationships may be the key element of a later cost-benefit analysis, when the
addict decides that these relationships are actually more valuable than getting
high. If the relationships are not present, the addict is another step closer
to the suicidal types of addictive behavior that arise when there is “nothing
left to lose.”

Paying attention is unlikely to cause harm, but active help
could either support or enable. It depends completely on the specific situation
and the actual intentions of the recovering person. Intentions are difficult to
judge, so we need to assess behavior. If I knew for sure that my loved one was
finally on the road to recovery, then I would do a lot to help make that journey
smoother and to prevent old problems from affecting the present. For instance,
I might pay off a drug debt to stop the dealer from “collecting,” and consider
that payment a loan payable at some later date. The problem is that we don’t
know until much later how firmly someone was on the road to recovery.

When you can help wholeheartedly, I suggest you do so. We are in
relationships to give and receive. A friend in need is a friend indeed. There
are two times to consider being wholehearted about giving: (1) early in an
addictive problem, after the first crisis or two, before someone has
established a history of twisting help into enabling, and (2) well into a
recovery process, when it is clear that even without you the person is likely
to continue to improve.

Aside from these two times, we typically need to be cautious
about actively helping, but not about simply paying attention. I suggest a few
simple guidelines. If you provide money, pay the bill or debt directly, not by
providing cash (you might be amazed how often this suggestion is ignored!).

Remember, it’s often easy to tell the difference between helping and enabling.
Provide a little help, and observe the effect. If it goes well, consider
another small helping step. Don’t help so much that it jeopardizes yourself,
because your help may be of no use and then you will both be in bad shape
(don’t spend money you don’t have).

Take care of yourself (and watch out for
your addictions). Someday, the person you love may be ready to meet you halfway,
and it would be good for you to be ready, too.

About Me

The Coleman Institute, the Advanced Center for Addiction Treatment, is recognized as one of the most successful and innovative outpatient accelerated detox centers for addiction treatment in the country with 10 offices in the U.S.
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